Building/Department(s): ______
Date: ______Time: ______Start ______Finished ______Start ______Finished
Inspector(s): ______Building Coordinator: ______
Checklist Items Yes No NA Checklist Items Yes No NA A. General-All Areas G. Storage – Fire Protection 1. Are all ceiling tiles in place and in good condition? 1. is the storage of combustibles in the work area held to a 2. Is all furniture in good/stable condition and properly adjusted? minimum to avoid a fire hazard? 3. Are wall-mounted book cases free of excessive material on top and 2. Is clearance of at least 18 inches maintained around fire and not overloaded? (Chemicals & heavy items should not be stored sprinkler heads? above head height (6 feet)). 3. Are flammable/combustible liquids in excess of one day’s 4. Are all walking or working surfaces free of tipping/slipping hazards? operational supply kept in approved flammable materials 5. Are emergency phone numbers and procedures posted at or near storage (FMS) cabinets? telephones? 4. Are all FMS cabinets free of combustible materials (cardboard, 6. Are all fans equipped with a blade guard with openings no greater paper, plastic, etc.)? than ½ inch? 5. Are all flammable containers properly closed/covered to 7. Is consumption of food, beverage, etc., prohibited where required? control vapors?
6. Are all flammable/combustible containers properly labeled/ B. General – Shops identified? 1. Are machine and belt guards in place and in good condition? 7. Are all refrigerators used for storage of flammable/combustible 2. Is pedestal machinery securely anchored to the floor? liquids/materials approved and explosion proof? 3. Is equipment properly maintained and adjusted to prevent personal 8. Are flammable/combustible liquids returned to approved flamm- injury and equipment damage? able liquid storage cabinets at the end of the workday?
4. Are compressed air nozzles at the correct pressure of 30 psi or less? H. Storage – Compressed Glass Cylinders 1. Are all cylinders properly secured with straps or chains to 5. Is all piping appropriately identified as to contents/direction of flow? prevent tipping/falling? 6. Are hot pipes and surfaces guarded against contact and clearly 2. Are protective valve caps in place when cylinder is not in use? marked “HOT”? 3. Are empty and full cylinders stored separately? 7. Are areas requiring use of protective equipment (e.g., Eye Protection 4. Are only chemically compatible cylinders stored together? Required, etc.) adequately posted with warning signs and enforced? 5. Are cylinder contents adequately labeled and easily seen? 8. Is damaged/malfunctioning equipment tagged “OUT OF SERVICE”? 6. Is the correct regulator being used for the cylinder service? C. Exits/Corridors 7. Are highly toxic gases stored in vented gas cabinets? 1. Are all corridors unobstructed? I. Personal Protective Equipment 2. Are all exit doors unobstructed? 1. Is the requirement of use of protective equipment enforced? 3. Are exit signs posted and properly illuminated to clearly indicate 2. Is the required personal protective equipment worn? exits? 3. When not in use, is personal protective equipment properly 4. Are all exit doors able to be opened from the inside without special maintain/stored? knowledge/keys? 5. Are exit doors free of slide bolts or locks? 4. Is personal protective equipment readily available for all D. Electrical personnel including visitors to the area?
1. Is there at least three (3) feet clearance in front of electrical 5. Is all personal protective equipment free from damage and panels/breaker boxes? deterioration?
2. Are electric hand tools properly grounded/double insulated? 6. Are all employees using respiratory protection properly trained 3. Is the area free of extension cords? and authorized by EH&S? 4. Is all electrical equipment plugged directly into wall outlets? 7. Is self-contained breathing equipment properly maintained/ 5. Are all cords/plugs free from damage or deterioration? inspected? 6. Are switches and circuit breakers properly identified as to the J. Railing/Elevated Work Areas service they are in and to what they control? 1. Are drain openings/pits in the floor or walking surfaces guarded 7. Are circuit breaker panels free of combustible materials? to prevent tripping/slipping? 8. Are covers plates in place on junction boxes to eliminate exposed 2. Are toeboards in place on elevated platforms to prevent objects wiring? from falling off the platform? 9. Are “WARNING HIGH VOLTAGE” signs installed on high voltage 3. Are standard guardrails provided on elevated platforms? enclosures for systems rated 600V or over? 4. Are handrails provided and in good condition on stairways? 10. Is all electrical, including light fixtures, protected from physical 5. Are there provisions for safe access to elevated machinery/ damage by enclosure/guards? equipment? E. Emergency Equipment K. Ladders 1. Is emergency equipment (alarm pull boxes, eyewashes, showers, 1. Are portable ladders in good repair and safe to use? etc.) accessible and not blocked by equipment? 2. Are mobile ladder stands in good condition? 2. Are emergency eyewashes provided in the required chemical areas? 3. Are standard guardrails provided on elevated platforms? 3. Are emergency showers provided in the required chemical areas? 4. Are handrails provided and in good condition on stairways?
4. Is all emergency equipment in good condition? L. Forklifts 1. Are defective forklifts taken out of service and tagged “DO NOT 5. Are spill kits accessible and fully stocked per list? USE”? F. Storage – General 2. Are forklift inspection forms current and maintained in a file? 1. Is good housekeeping practiced in work area (Is it free of debris, 3. Are load limits clearly posted in the area? combustibles, obstructions? Are aisles maintained?)? 4. Are forklift operating rules clearly posted in the area? 2. Is storage adequately supported/stable to avoid tipping/falling? 5. Are all operators trained and authorized? 3. Is there at least two (2) feet clearance between stacked materials and ceiling light? Checklist Items Yes No NA Checklist Items Yes No NA M. Fire Protection O. Computer Rooms 1. Are there current welding permits displayed in welding area? 1. Are combustibles stored in approved, enclosed metal cabinets? 2. Is combustible waste, e.g., trash containers, cardboard boxes, 2. Are all self-closing doors operational? etc., removed from the room daily or more often as needed? 3. Are walls and floors free of holes/penetrations? 3. Is the computer room free of flammable/combustible liquids? 4. Are no smoking regulations clearly posted and being followed in 4. Are computer tapes stored in approved, enclosed metal “NO SMOKING” areas? cabinets? 5. Are fire extinguishers and signs clearly visible? 5. Is the raised floor free of unsealed cable holes? 6. Is the access to fire suppression and alarm systems 6. Is access to fire extinguishers clear and unobstructed? unobstructed? 7. Are all extinguishers in place and properly mounted? 7. Are floor tile pullers available and mounted? 8. Are all extinguishers properly inspected (monthly) and maintained 8. Are doors to the peripheral rooms closed? (annually)? N. Training 9. Is paper stored in computer room limited to a one day supply? 1. Have personnel been trained in the use of personal protective 10. Is the room free of repair shop operations? equipment? 2. Are all employees trained in hazardous substances safety? 11. Is the room free of soldering irons? 3. Have personnel working in high noise areas been trained in hearing 12. Is the room free of coffee makers, popcorn machines, electric conservation? floor/space heaters, etc.? 4. Have employees who use respirators been trained, fit tested, and 13. Are “NO SMOKING” signs posted and being enforced in received the required health monitoring examination? computer rooms? 5. Are employees who use self-contained breathing apparatus properly trained and authorized? P. Grounds 6. Evac Plans 1. 2. 3. 4.
Explanation/Comments on all NO Answers Explanation/Comments on all NO Answers